How HSA and FSA Reimbursement Works (Step by Step)
How to reimburse yourself from an HSA or FSA: where the button is at Optum, HealthEquity, Fidelity, WEX and others, what receipts need, and the deadlines.
7 minute read
Short answer
Reimbursement means you pay for a medical expense with your own money, then ask your HSA or FSA to pay you back. You log in to your plan's website or app, click something like "Reimburse Myself" or "File a Claim," enter the amount and date, attach the receipt (and a letter of medical necessity if the item needs one), and the money is sent to your bank account or mailed as a check. HSAs let you do this any time, with no deadline. FSAs tie it to your plan year.
If the item needs a letter, Burst can write the letter for $35 and file the claim for you.
What are the two ways to pay with an HSA or FSA?
You can swipe the plan's debit card at checkout, or you can pay with anything else and get reimbursed later. The card is convenient at a pharmacy. It fails at a gym, at a mattress store, on a Peloton order, and on a mixed cart at Target where half the items are not medical. Reimbursement works everywhere, because the store is not involved. You buy the item the way you buy anything else, and the paperwork happens between you and your plan afterward.
When do you have to use reimbursement instead of the card?
In four situations, and the first two cover most people.
The store does not take the card. Most gyms, studios, and direct-to-consumer brands do not. Many online checkouts reject the card outright.
The item needs a letter of medical necessity. Walking pads, saunas, mattresses, air purifiers, supplements, and memberships are not on the automatic list. The card usually declines on them, and even when it goes through, your plan will ask for the letter later.
You want to use a rewards card on purpose. Paying a $2,500 mattress on a card that earns 2% and then reimbursing yourself is legal and common. Fidelity and HealthEquity both describe it in their own help articles.
The card declined on a mixed cart. Groceries plus allergy medicine at one register trips the card. Pay for everything with your regular card and file for the medicine.
How do I get reimbursed from my HSA?
Log in to your HSA provider, find the pay-yourself button, enter the amount, and pick where the money goes. HSA providers do not require you to upload the receipt at the time of the request; you keep it for your own records in case the IRS asks. Here is where the button lives at the seven biggest providers.
Provider | Where to click | How you get paid |
|---|---|---|
Optum Financial | "Reimburse Myself" at the top of the site, or "Make a payment" in the app | Direct deposit if you have linked a bank account; otherwise a mailed check |
HealthEquity | "Reimburse Me" under Health Savings Account on the member home page | EFT to a verified bank account or check; typically processed within three business days |
Fidelity | Transfer from the HSA to a linked bank account or another Fidelity account | EFT, check, or internal transfer. If the money is invested, Fidelity sells first and settlement can take up to ten business days |
WEX | "Reimburse Myself," then "Distribution" in the app | Your choice of method from the drop-down at submission |
Inspira Financial (formerly PayFlex) | Request a withdrawal on the site or in the Inspira Mobile app | Deposited to your checking or savings account |
Lively | "Add New Expense" on the dashboard | Transfer to your linked bank account |
HSA Bank | Schedule a transfer to an external bank account from the member site or app | Transfer to your personal checking or savings; $2,500 daily transfer limit |
Linking your bank account before you need it is the single thing that speeds this up. A check adds a week or more.
How do I get reimbursed from my FSA or HRA?
You file a claim and attach proof. FSAs are stricter than HSAs: the administrator has to see documentation before it releases the money, so every claim needs an itemized receipt, and letter items need the letter attached too. Look for "File a Claim," "Submit a Claim," or "Pay Me Back" in your portal. Most administrators pay approved FSA claims within a few business days to two weeks. An HRA works the same way as an FSA, except your employer decides what the account covers, so check its summary before you buy anything that needs a letter.
What does a receipt need to show?
Four things: the date, the seller, what you bought, and what you paid. A credit card statement line that says "AMAZON $399.00" is not enough, because it does not say what the item was. The order confirmation page or the emailed invoice is what you want. For a letter item, the description on the receipt has to line up with the item named in the letter. For a membership, a monthly statement from the gym or the app's billing history works.
Is there a deadline to reimburse yourself?
For an HSA, no. The IRS says a distribution can pay back an expense from any prior year as long as the expense happened after the HSA was opened. People use this on purpose: pay cash now, let the account grow, reimburse years later. Keep the receipts.
For an FSA, yes. The expense has to fall inside the plan year (or the grace period, if your plan has one), and you have to file the claim before the run-out period ends, often March 31 for a calendar-year plan. Miss it and the money is gone.
For an HRA, your employer's plan document sets the deadline.
A worked example in dollars
You have high blood pressure and your clinician writes a letter for a home walking treadmill. You buy a WalkingPad C2 for $399 on your Chase Sapphire card and earn points on it. You log in to HealthEquity, click "Reimburse Me," enter $399 and the purchase date, upload the receipt and the letter, and three business days later $399 lands in your checking account. The $399 came out of your HSA, where it was never taxed. If you are in the 22% federal bracket and pay 7.65% in payroll taxes, that $399 of pre-tax money would have cost you about $567 in gross pay to earn and spend after tax. Your card statement still shows the purchase; your bank account shows the deposit.
Can you get cash back with your HSA card?
Not at the register, in most cases. Some HSA debit cards work at an ATM, but every dollar you withdraw is a distribution, and any dollar not matched to a medical expense is taxed as income plus a 20% penalty if you are under 65. If you want the money in your own account, use the reimburse-yourself feature and keep the receipt that justifies it.
How to get a letter for purchases your plan will not take on a receipt alone
Go to app.getburst.com/request-lmn and describe the item and the condition it is for. It takes under 2 minutes and costs $35, one time.
A licensed clinician looks at what you sent. When a letter fits, it comes back signed in your inbox, usually the same day. When it does not, the $35 is refunded automatically.
Make the purchase at whatever store you like, on whatever card you like, and forward Burst the receipt.
Burst submits the claim to your administrator, who pays you from the account by deposit or check. A denied claim means your $35 comes back.
Frequently asked questions
How long does HSA reimbursement take?
Usually one to five business days by direct deposit once you submit, depending on the provider. Checks take longer, and Fidelity can take up to ten business days if it has to sell investments first.
Can I reimburse myself from my HSA for a purchase I made years ago?
Yes, as long as the HSA was already open when you made the purchase and you have the receipt. There is no IRS time limit.
Do I need a letter of medical necessity for every reimbursement?
No. Prescriptions, copays, glasses, contacts, over-the-counter medicine, and period products need only a receipt. A letter is for items your plan treats as personal unless a clinician ties them to a condition.
Does the letter need to be dated before the purchase?
Yes. Request it before you place the order; a letter dated after the receipt will not support the claim.
Can my plan deny a reimbursement?
Yes. The plan administrator makes the final call on every claim. That is why Burst refunds the $35 when a plan denies a claim backed by a Burst letter.
Related: How can I reimburse purchases from my FSA?, How to file your letter of medical necessity, Lost your receipts?, and HSA vs. FSA.
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